Summary #5 eating disorders
= characterized by a persistent disturbance in eating behavior that impair health or ability to
function well.
Anorexia nervosa (AN)
Significantly low weight: BMI below 18 or weight below 50% of suggested body weight
Two types
1. Restricting AN
= limitation of quantity of food consumed
2. Binge-purging AN
= purging out the consumed food through
vomiting, laxatives, exercise
(difference with bulimia = significantly low
weight)
Main features
- Self-starvation
- Pathological fear of gaining weight
- Refusal to maintain minimal body weight
- Distorted body image
What is purging?
Getting rid of the consumed food/calories
through various strategies such as self-induced
vomiting, use of laxatives
Epidemiology
- Onset:
shift to earlier ages (8-13), typical onset 16-20 years
- prevalence:
1.2% life time prevalence
- Gender difference:
3:1 ratio (women: men)
= 0.9% women & 0.3% men
- Prognosis
1 study: 51% fully recovers; 16% died; 10% still suffering; 21% partial recovery. 10-15 years
after diagnosis 70% no longer meet diagnostic criteria, but still struggle with eating.
Gender differences used to be overrated
thought to be a women’s disorder (old studies: ration is 10:1), however the prevalence
across males is probably underestimated due to:
- Underdiagnoses (different symptoms, more focused on become muscular/gym)
- Social views
Who are sensitive to developing AN
- Athletes (especially ballet dancers, or those who have to ‘make weight’)
- Homosexual men, because they have to be attractive to men (generally prefer a
slender partner)
5-8% mortality rate amongst those diagnosed.
, = due to weakened heart muscle (‘eaten’ away due to lack of other resources) + 1/5 suicide,
expansion of stomach, kidney damage, impaired immune functioning.
AN in general:
- Often accompanied by amenorrhea (=cessation of menstruction) though it’s not
required for the diagnosis of AN.
- Patients are often aware of others judging their life style hide thinness, with baggy
clothes, drink water to weigh more, eat separately
- Patients often have difficulty recognizing the seriousness of their condition.
- AN is found cross-culturally and throughout history
- Incidence of AN has increased since early part of 20th century
- Caucasians are more likely to develop than minorities.
- Median number ffrom onset to remission is 7 years in women
Medical indications/biological features
- Hypothermia (=always cold)
- Lanugo
- Hypertension
- Lower bloodpressure/weaker heart
- More miscarriages/PPD
- Amenorrhoea; absence of menstruation
- Lack of vitamin B (cognitive deficits/depression)
- Longterm: osteoporosis (weaker bones due to malnutrition during the period in
which bones strengthen)
- Lack of electrolytes: heart/kidney failure (no action potential)
- Yellow color
- Brittle hair/nails
- In case of ‘binge-purging subtype’: dental enamel
Comorbidity
- Depression (50-68%)
- OCD (15-69%)
- Anxiety (
- Substance abuse (mainly related to purging)
- Panic disorder/agoraphobia
Bulimia Nervosa
= characterized by a persistent disturbance in eating behavior that impair health or ability to
function well.
Anorexia nervosa (AN)
Significantly low weight: BMI below 18 or weight below 50% of suggested body weight
Two types
1. Restricting AN
= limitation of quantity of food consumed
2. Binge-purging AN
= purging out the consumed food through
vomiting, laxatives, exercise
(difference with bulimia = significantly low
weight)
Main features
- Self-starvation
- Pathological fear of gaining weight
- Refusal to maintain minimal body weight
- Distorted body image
What is purging?
Getting rid of the consumed food/calories
through various strategies such as self-induced
vomiting, use of laxatives
Epidemiology
- Onset:
shift to earlier ages (8-13), typical onset 16-20 years
- prevalence:
1.2% life time prevalence
- Gender difference:
3:1 ratio (women: men)
= 0.9% women & 0.3% men
- Prognosis
1 study: 51% fully recovers; 16% died; 10% still suffering; 21% partial recovery. 10-15 years
after diagnosis 70% no longer meet diagnostic criteria, but still struggle with eating.
Gender differences used to be overrated
thought to be a women’s disorder (old studies: ration is 10:1), however the prevalence
across males is probably underestimated due to:
- Underdiagnoses (different symptoms, more focused on become muscular/gym)
- Social views
Who are sensitive to developing AN
- Athletes (especially ballet dancers, or those who have to ‘make weight’)
- Homosexual men, because they have to be attractive to men (generally prefer a
slender partner)
5-8% mortality rate amongst those diagnosed.
, = due to weakened heart muscle (‘eaten’ away due to lack of other resources) + 1/5 suicide,
expansion of stomach, kidney damage, impaired immune functioning.
AN in general:
- Often accompanied by amenorrhea (=cessation of menstruction) though it’s not
required for the diagnosis of AN.
- Patients are often aware of others judging their life style hide thinness, with baggy
clothes, drink water to weigh more, eat separately
- Patients often have difficulty recognizing the seriousness of their condition.
- AN is found cross-culturally and throughout history
- Incidence of AN has increased since early part of 20th century
- Caucasians are more likely to develop than minorities.
- Median number ffrom onset to remission is 7 years in women
Medical indications/biological features
- Hypothermia (=always cold)
- Lanugo
- Hypertension
- Lower bloodpressure/weaker heart
- More miscarriages/PPD
- Amenorrhoea; absence of menstruation
- Lack of vitamin B (cognitive deficits/depression)
- Longterm: osteoporosis (weaker bones due to malnutrition during the period in
which bones strengthen)
- Lack of electrolytes: heart/kidney failure (no action potential)
- Yellow color
- Brittle hair/nails
- In case of ‘binge-purging subtype’: dental enamel
Comorbidity
- Depression (50-68%)
- OCD (15-69%)
- Anxiety (
- Substance abuse (mainly related to purging)
- Panic disorder/agoraphobia
Bulimia Nervosa
